Safety Of Timolol Research Articles

Pharmacogenetics and Pharmacokinetic Topical Levofloxacin on Cataract Surgery

The fluoroquinolones (FQs) have proven to be successful for treating ocular infections because the introduction of ciprofloxacin and ofloxacin; the improvement in ofloxacin to levofloxacin, the active l-isomer of ofloxacin; and the targeting of Gram-positive bacteria by moxifloxacin and gatifloxacin with a dual mechanism of action. The in vitro testing of the FQs has determined that moxifloxacin and gatifloxacin are more potent anti-infectives with lower minimum inhibitory concentrations (MICs) to Gram-positive bacteria than the earlier generations of FQs, but no real advantage for in vitro susceptibility has been noted among the FQs for Gram-negative bacteria. The objective of this review is to outline the pharmacogenetics, pharmacokinetics, and efficacy of levofloxacin along with the impact on patients’ life. Such particular approach, being the foundation of personalized medicine, increases efficacy and safety of timolol while reducing costs by using targeted doses.

Efficacy and safety of timolol and latanoprost in the treatment of primary open-angle glaucoma

Background: Glaucoma is a chronic, progressive optic neuropathy which leads to optic nerve damage and loss of visual function. Elevated intraocular pressure (IOP) is the most important and only modifiable risk factor. Hence, the goal of glaucoma therapy is to lower IOP, and ocular hypotensive agents have the potential to prevent optic nerve damage and preserve vision. Aims and Objectives: Aims and objectives of the study are to compare the efficacy and safety of timolol 0.5% versus latanoprost 0.005% in the treatment of primary open-angle glaucoma (POAG). Materials and Methods: A total of 60 newly diagnosed patients of POAG who fulfilled the inclusion/exclusion criteria were enrolled and randomized into two groups of 30 each to receive timolol 0.5% twice daily and latanoprost 0.005% once daily in the evening. IOP was recorded at baseline and each follow-up visit. The patients were followed every 4 weeks for 12 weeks. Adverse effects, if any, were also recorded at each visit. Results: At 12 weeks both timolol and latanoprost effectively reduced IOP, but the reduction was significantly greater (P < 0.0001) with latanoprost (7.97 ± 1.27 mmHg, 31.25%) compared with timolol (6.77 ± 1.48 mmHg, 25.9%). More number of eyes (χ2 = 4.6, df = 1, P = 0.032) treated with latanoprost (46, 76.6%) achieved a specific target IOP as compared to those treated with timolol (35, 58.3%). Both the study medications were well tolerated. Conclusion: Latanoprost was found to be more potent and efficacious in reducing IOP with good tolerability in patients with POAG.

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Efficacy and Safety of Topical Timolol Eye Drops in the Treatment of Myopic Regression after Laser In Situ Keratomileusis: A Systematic Review and Meta-Analysis

Aims. The aim of this study was to assess the efficacy and safety of timolol in the treatment of myopic regression after laser in situ keratomileusis (LASIK). Methods. We searched MEDLINE, CENTRAL, EMBASE, China National Knowledge Infrastructure (CNKI), and Chinese Biological Medicine (CBM) from the inception to July 2015 for relevant randomized controlled trials that examined timolol therapy for myopic regression. The methodological quality of the studies included was assessed using the Revman 5.3 software. Results. We included six clinical trials involving 483 eyes in this review, including 246 eyes in treated group and 237 eyes in controlled group. We observed statistically significant improvements on the postoperative SE in the 3 months. However, the change of CCT was not statistically different between the control group and the experimental group. There were fewer cases of IOP, UDVA, and CDVA in treated group having significant difference from the controlled group. Conclusions. Topical timolol could be an effective treatment for reduction of myopic regression especially the spherical errors after myopic LASIK. Further RCTs with larger sample sizes for these trials are warranted to determine the efficacy and limitation for myopic regression after LASIK.

Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants

Timolol has been demonstrated to be efficacious in the topical treatment of superficial infantile hemangiomas (IHs). We conducted a prospective study to evaluate the short-term efficacy and safety of timolol in the treatment of superficial IH in Chinese infants. From March to November 2012, 124 patients with superficial IHs were included in the prospective study. The patients were divided into two groups: treatment (101 patients, the timolol drops were administered on the surface of the lesions three times daily, and erythromycin ointment was applied around the lesions) and observation (23 patients, without treatment). The results were categorized into three grades: class 1 (ineffective), class 2 (controlled growth) and class 3 (promoted regression). Within one week of the initiation of timolol treatment, a number of the lesions became softer and lighter in color. Four months following the initiation of timolol treatment, the overall response was class 1 in eight patients (7.9%), class 2 in 36 patients (35.6%) and class 3 in 57 patients (56.4%). Complete tumor regression was observed in 12 patients. No adverse effects were recorded during the treatment period. Among the patients in the observation group, there were 15 class 1 patients (65.2%), seven class 2 patients (30.4%) and only one class 3 patient (4.3%). In conclusion, timolol is an effective and safe treatment for superficial IH. In addition, it may be used in the treatment of proliferative superficial IH, particularly in infants within 6 months of age.

Timolol versus brinzolamide added to travoprost in glaucoma or ocular hypertension

To compare the efficacy and safety of timolol 0.5% versus brinzolamide 1.0% when added to travoprost monotherapy in patients with primary open-angle glaucoma or ocular hypertension. Patients meeting selection criteria (IOP one eye 19mmHg and ≤32mmHg and IOP both eyes ≤32mmHg at 8:00h) were switched to travoprost monotherapy for 4weeks. Patients then insufficiently controlled on travoprost (IOP at 8:00h ≥19mmHg) at baseline were randomized to receive either travoprost and brinzolamide or travoprost and timolol in a double-masked fashion for 12weeks. Two hundred and fifty-three patients underwent the 4-week run-in period. Switching to travoprost resulted in adequate IOP control (<19mmHg) for 21.7% of patients. After 3months of treatment, both drug combinations statistically significantly reduced the mean IOP at each time point (8:00, 12:00 and 16:00h) and the mean diurnal IOP, which was 17.9 ± 2.6mmHg for the brinzolamide group and 17.0 ± 3.2mmHg for the timolol group. Both combinations were well-tolerated. However, a statistically significant difference occurred at 16:00 h, with pressures of 16.4 ± 3.2mmHg and 17.3 ± 2.8mmHg for the timolol and brinzolamide groups, respectively (p = 0.038). Fifty percent of patients reported one adverse event, whereas in 13.2% three or more adverse effects were named. Hyperemia was found most often (6.3% of the patients). Both adjunctive combinations moderately reduced IOP in patients inadequately controlled with travoprost monotherapy, with timolol being slightly stronger 8 hours after instillation. Adjunctive treatment with brinzolamide and travoprost may be an alternative for patients not tolerant or not responsive to treatment with timolol and travoprost.

Timolol 0.5%/dorzolamide 2% fixed combination vs timolol maleate 0.5% and unoprostone 0.15% given twice daily to patients with primary open-angle glaucoma or ocular hypertension

Objective To compare the efficacy and safety of timolol 0.5%/dorzolamide 2% fixed combination vs timolol maleate 0.5% and unoprostone 0.15% given twice daily. Design Prospective multicenter, randomized, double-masked, crossover comparison study. Methods Primary open-angle glaucoma or ocular hypertension patients were randomly assigned to one of the treatment groups for a 6-week treatment period and then crossed over to the opposite treatment. Diurnal curve testing was performed at 8:00 am, 10:00 am, 4:00 pm, 6:00 pm, and 8:00 pm at baseline and the end of each treatment period. The run-in medicine was timolol twice daily for 28 days. Results Thirty-two patients completed this trial. The baseline trough pressure was 24.3 ± 3.0 mm Hg, and the diurnal curve was 23.4 ± 3.2 mm Hg. For the fixed combination the treatment trough pressure was 20.8 ± 4.1 mm Hg and the diurnal curve was 19.6 ± 3.6 mm Hg, whereas timolol and unoprostone concomitant therapy showed a treatment trough pressure of 20.1 ± 4.5 mm Hg and a diurnal pressure of 19.8 ± 4.1 mm Hg. There was no significant difference between treatment groups at any time point, for the diurnal curve, or in the extended reduction from baseline. There was no difference between treatment groups regarding ocular and systemic unsolicited or solicited adverse events. Burning, stinging, and conjunctival hyperemia were the adverse events most noted. There were no serious adverse events during this trial. Conclusions This study suggests that both timolol/dorzolamide 2% fixed combination and concomitant timolol maleate 0.5% and unoprostone 0.15% therapy provide similar efficacy and safety throughout the daytime diurnal curve.

The safety and efficacy of timolol 0.5% in xanthan gum versus timolol gel forming solution 0.5%

Purpose. To evaluate the efficacy and safety of timolol maleate 0.5% gel forming solution (TXE, Merck) versus timolol maleate 0.5% gel forming solution (TXG, Falcon) in primary open-angle glaucoma and ocular hypertension patients. Methods. Following a washout period patients were randomly begun on either TXE or TXG each given once each morning for six weeks (Period 1). Patients then were crossed over to the opposite medicine for Period 2. Following each 6-week treatment period the intraocular pressure was obtained at 08:00 trough and +2 and +8 hours post-dosing. Anterior segment staining and photography were performed to assess surface irritation. Results. Thirty-two patients were enrolled in this study; 28 completed. The diurnal intraocular pressure as well as the 08:00 trough and +2 hour post dosing pressures were statistically equal between groups, although a trend to a lower mean pressure was observed in the TXE (17.9 ± 3.2mmHg) compared to the TXG (18.6 ± 3.4mmHg) group. However, eight hours after dosing the pressure was 17.5 ± 3.2mmHg in the TXE group and 18.9 ± 3.3mmHg in the TXG group (P = 0.0019). Safety was similar between groups, including corneal and conjunctival staining, conjunctival hyperemia graded by anterior segment photography and at the slit lamp, and unsolicited and solicited side effects. Vision recovery after instillation was similar between groups. Conclusion. TXE demonstrates a lower intraocular pressure eight hours after dosing than does TXG, but safety appears similar between products.

Six-Month Comparison of Bimatoprost Once-Daily and Twice-Daily with Timolol Twice-Daily in Patients with Elevated Intraocular Pressure

The efficacy and safety of bimatoprost, a member of a new class of pharmacological agents called prostamides, were compared with the efficacy and safety of timolol in patients with glaucoma or ocular hypertension. Pooled 6-month results from two ongoing, multicenter, randomized, double-masked, clinical trials were analyzed. Patients were randomized in a 2:2:1 ratio to treatment with bimatoprost 0.03% once a day ([QD] n = 474), bimatoprost 0.03% twice a day ([BID] n = 483), or timolol 0.5% BID (n = 241). Scheduled visits were at prestudy, baseline, week 2, week 6, month 3, and month 6. The primary outcome measure was in diurnal intraocular pressure ([IOP] 8 am, 10 am, 4 pm, 8 pm). Bimatoprost QD provided significantly greater mean IOP reductions from baseline than timolol at every time of the day and at each study visit (p ≤ .05). BID dosing of bimatoprost also provided significantly greater mean IOP reductions than timolol at most timepoints, but was not as effective as QD dosing. The IOP lowering provided by bimatoprost QD was sustained for 6 months. At month 6, the mean IOP reduction from baseline at 10 am was 8.1 mm Hg (33%) with bimatoprost QD, 6.3 mm Hg (26%) with bimatoprost BID, and 5.6 mm Hg (23%) with timolol. Low target pressures were achieved by a significantly higher percentage of patients in the bimatoprost QD group than in the timolol group. At 10 am (peak timolol effect) at month 6, IOP ≤ 17 mm Hg was achieved by 63.9% of bimatoprost QD patients, compared with 37.3% of timolol patients (p < .001). Bimatoprost was safe and well-tolerated, with few discontinuations due to adverse events. The most frequent side effect was trace-to-mild conjunctival hyperemia. Changes in iris pigmentation were reported in 1.1% of bimatoprost patients. There were no other significant findings in slit lamp examinations, ophthalmoscopy, visual acuity, or visual fields, and systemic safety parameters were also unaffected. Together these results indicate that bimatoprost QD is statistically and clinically superior to timolol in lowering IOP, and is safe and well-tolerated in patients with glaucoma or ocular hypertension.

Timolol in the therapy of “ocular hypertension”

Timolol has been shown to be at least as effective as pilocarpine and epinephrine in the therapy of open angle glaucoma. To date there appear to have been few serious side effects from timolol when it has been used in patients without cardiac or pulmonary disease. The decision whether and when to treat a patient with elevated intraocular pressure depends upon a weighing of risk of glaucoma damage versus the side effects of the drugs used in therapy. The use of the beta blocking agents, particularly timolol, in the therapy of ocular hypertension is considered. Reports on the efficacy and safety of timolol are cited, and the authors' reevaluation of their own series of patients treated with timolol for 17–36 months is discussed.